Post Finasteride Syndrome + Low DHT, High Free T

Pharma / TRT Testosterone Replacement
1

Hi guys,

This is my first post. I wanted to see what you all would think about my case since there is so much expertise on this forum. I am pretty desperate so I am willing to try anything.

Before I give you my stats and my blood work, the most important thing to note is that I have had Post Finasteride Syndrome for 3 years now (symptoms below). Before that, I took Finasteride 1.25 mg/day for hair loss for 8 years.

I haven’t been to an endocrinologist yet because most endos still dismiss PFS from what I have heard.

The gist of my blood work is that I have low DHT and high Free T and Progesterone (interestingly, both of these are used to form metabolites through the action of 5a-reductase, which is the same enzyme targeted by Finasteride).

The main current theory of PFS is that an epigenetic change is triggered, permanently shutting down gene expression, following changing androgen levels at the backdrop of upregulated androgen receptors from finasteride use.

Stats + Lifestyle:
Age: 40
Weight: 65 kg
Height: 187 cm
Body fat: Very low
Body type: Slim, Toned
Hair loss: Early stage + Accelerating since stopping Finasteride
Exercise: None (severe joint pain)
Supplements: None
Medications: None
Diet: High protein

Symptoms:
Complete absence of libido
No nocturnal, morning or spontaneous erections
Erectile Dysfunction
Low penis sensitivity
Weak, pleasureless orgasms
Shrunken (atrophied) penis, scrotum and testicles
More prominent veins on penis
Anhedonia, lack of motivation, depression, apathy
Skin drier than before (less acne)
Dry hair (straw looking)
Urinary problems - urinary incontinence, reduced flow
Severe joint pain - all joints but mostly hip and knees

Blood Work

Test Measure Unit Reference
DHT 175* pg/ml 300-850
Testosteron free 29.27* pg/ml 7.0 - 22.7
Progesterone 0.783* nmol/l <0.474
17 - OH progesterone 1.17 ng/ml <1.39
Androstanediol-glucuronide 419 ng/dl 168 - 3530
Pregnenolone-17-Hydroxy 292 ng/dl 30.0 - 350
Prolactin 107.3 mIU/L M 86 - 324
LH 4.3 mIU/ml М 1.7 - 8.6
FSH 2.5 mIU/ml M 1.5 - 12.4
Testosterone 21.45 nmol/l 9.90 - 27.80
DHEA-S 149.4 µg/dl 88,9 - 427
Estradiol 80.41 pmol/l 41.40 - 159.00
Androstenedione 7.70 nmol/l М 2.1 - 10.8
SHBG 33.4 nmol/l 14.5-48.4;
FT 3 (Free Т3) 4.6 pmol/l 3.20 - 6.80
FT 4 (Free Т4) 14.37 pmol/l 12.00 - 22.00
TSH 1.26 mIU/l 0.300 - 4.200
fPSA (free)/tPSA(total) 35 % >25%
fPSA 0.182 µg/l
tPSA 0.524 µg/l <4.000

I would really appreciate everyone’s opinion what I should do.

Thanks for reading!

2

You’re tests show excellent testosterone panel, but you seem to be suffering the effects of low testosterone and low estrogen, add to that fact that DHT is below range and progesterone is high.

You seem to have lost the ability to process androgens, classic PFS. I don’t think there’s a doctor on earth that knows how to treat you, I don’t know how your doctors can dismiss PFS if they cannot explain what is going on.

I think the only thing you can do now is pray and hope your body heals itself. If this gene expression change did occur, then I don’t see how its possible to recover.

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3

Yes, it seems the body is resistant to androgens.

In my case, would it make sense to supplement DHT?

Doctors usually deny PFS by saying it’s all in your head… Or they deny this was caused by Finasteride and start looking for other reasons such as stress.

4

I have some form of damage from finasteride, but my blood panels were completely different from yours… When I was on finasteride and had tests my testosterone was in the 200s, when I stopped it rose back up but left my shbg very high with a subsequent low free t. I got on trt and with some trial and error feel 100%.

This is a hormone profile I’ve not seen before regarding people with finasteride damage. Perhaps there’s two types of hormone profiles that accompany it.

Regardless, you don’t have anything to lose regarding supplementing dht.

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5

Thats why the finasteride shit should be forbidden and labeled as a poison. I’m sick of guys telling how they cannot loose their hair…ok then loose your life instead.

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6

I am glad to hear you are 100%! It is so rare to see PFS recovery stories, even with TRT.

I have also come to believe there are two sub-types of PFS. The first one does not have severe gene expression changes but have their hormones all messed up. This subtype usually improves gradually on their own and recovers completely. They also respond to hormone therapy.

The second type has the epigenetic changes. Their hormones are fine but nothing works. This type does not respond to hormone therapy and does not improve no matter what. I seem to fall into this type, although my low DHT gives me some hope.

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There is a doctor I believe that can help you, of course not guarantees given. I know he has some experience with PFS patients. He is in USA, but he is doing telemedicine.

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I agree completely but nevertheless keep in mind that guys who start finasteride now, despite all the available information, are still being massively lied to and information about PFS is 100% being suppressed, including on Wikipedia.

When I started Finasteride in 2009 (and did extensive research about it), there was no PFS Foundation yet, there were no academic papers on PFS, no credible-looking evidence for the harms of finasteride, nothing on permanent effects on the drug leaflet, except of course PropeciaHelp which is so easy to dismiss as a bunch of lunatics, especially when the entire scientific/medical community is united in telling you finasteride is the safest drug ever invented…

9

@samguy19 out of interest, what did your pre-TRT basic hormone panel look like (LH,fsh,shbg,ft,tt)? I’m In a similar situation with finasteride damage. The drug has appeared to damage my testies and left me with high SHBG, killing free T into oblivion.

OP, I’ve seen people recommended DHT prohormones before, could warrant further research with your blood work

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10

Well studies in mice show similar side effects to PFS that do not resolve after quitting the drug, the makers of finasteride or drugs in general do not tell doctors everything and withhold information because otherwise damage to sales will result before the drug is ever released.

Just look at how everyone was misled to believe the new version of opioids were less addictive and safe. I do not trust manage healthcare doctors to be informed and to trust the pharmaceutical companies with my safety, I only trust them to do what’s in their best interest.

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11

Yes, absolutely. Finasteride is not the only case. In fact, most drugs follow a similar pattern. Millions of people are damaged or killed by harmful or unnecessary drugs.

Vioxx – also produced by Merck, FDA approved, and now withdrawn – is a textbook case of deliberate and systematic deception of the public, at the cost of 100,000 lives. Opioids are a great example as well. Don’t even want to start talking about psychiatric drugs.

And yet, if you read Wikipedia’s article on Finasteride – controlled by a couple of Merck-paid editors, who make me hate myself for being part of the human species – you will see nothing about Post Finasteride Syndrome, about the countless animal trials with Finasteride, or even about the permanent side effects now explicitly stated on the drug leaflet. There is nothing there about the permanent chemical castration of young innocent men, about the destroyed careers and lives, about the suicides…

Peter Gøtzsche, the co-founder of the Cochrane Collaboration, has likened the pharmaceutical industry to organized crime.

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Horrible drug that should be taken off the market, but won’t be due to profit.

I haven’t taken it personally but I was “poisoned” another antibiotic called Cipro, that has literally disabled people. Got horrific brain fog (that I still have to this day) and tendon damage. Still recovering to this day and it’s been six months…

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13

Sorry to hear! I have taken Moxifloxacin, which is similar to Cipro. After a couple of days all of a sudden I got strong pain in the muscles/tendons on my back - as if I had pulled my rhomboid muscles. I did some research and found out about the drug’s effects on tendons and ligaments. Needless to say I stopped it immediately. The pain went away gradually over the course of a week.

Since then my joints have deteriorated greatly though. I can barely walk more than 10 meters now and I avoid leaving the house. I don’t think it is from Moxi though because I have had the pain for more than a year, way before I took Moxi. I always assumed it was from PFS, due to androgen insensitivity that results in weakening of the tendons and ligaments that hold the joints together. Moxi could have made it worse though. I don’t know…

14

I’ve heard of a few guys recovering from PFS via (managed) TRT and monitoring E2 extremely closely. Estrogen by it’s it very nature can create an inflammatory environment in the body, and I think PFS guys have it a lot worse due to the alternations to the receptor sites as mentioned in your initial post. Generally speaking, joint pains (and issues) IS E2, but you’ve definitely got somewhat of a double whammy as Moxifloxacin is part of the FQ family and will have similar effects to Cipro.

In your position I would look at starting TRT, with HCG on ED or EOD shots. Your symptoms are actually pretty similar to mine (which were due to a varicocle in my case), where E2 was low and progesterone elevated. Progesterone blocks DHT (and E2) and I have a theory that PFS guys have elevated progesterone to counteract the negative impact of estrogen on the body. Progesterone is beneficial because it “calms” the CNS, but also stops DHT functioning causing sexual issues.

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I was able to overcome almost all the tendon issues via high dosages of magnesium, B6 and Vitamin C (which is required to build collagen). Making sure every single vitamin is optimised is critical in building tissue in the body and recovering from damage from drugs. Definitely consider getting a full panel done if you can.

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Additionally, estrogen is also required (along with with optimal T3) to build collagen, tendon and connective tissue.

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17

Wouldn’t it make more sense to start using a DHT cream since my DHT is so low? Raising DHT will bring down Free T too, as that is elevated.

I have no idea what the long term effect of that will be though. One possibility is that androgen receptors will get down-regulated, which is good, and the other is that epigenetic blockage of gene expression will get even worse. Many PFS guys seem to suffer from the latter when they raise androgens…

By the way, I tried to find Andractim (DHT gel) and it looks to be out of stock everywhere. Is there anything similar on the market at all?

18

The answer to that is both yes and no, since DHT and E2 regulate the HPTA feedback loop so by supplementing with DHT you could potentially risk shutting yourself down more. E2 is required for the aggressive/competitive libido in males, so you need that as much as DHT.

It’s a tough call, but I would be tempted to try TRT and monitor everything extremely closely with a proper specialist.

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19

See, I don’t necessarily agree with that. I have been on the propecia boards and here and seen guys recover. It seems a lot of sufferers have used very short lived protocols or else a mixture of creams/gels. Many men on those boards seem to be afraid to use TRT at all because of the idea that it may make them worse. So no, I think recovery is very possible and have spoken to a number of PFS educated Drs that have seen success as well.

To your point, I usually see hormone profiles with high SHBG and low T. Sometimes the E2 is messed up as well. Yours is different and seems to suggest that your 5AR2 is messed up or permanently inhibited (finasteride typically raises T in normal responders as it doesn’t turn into DHT). It may be worth supplementing with a DHT cream and seeing what effect that has. Certainly would not hurt to give it a shot after 3 years of suffering.

Someone asked for my bloods prior to TRT. This is 5 months post discontinuation of fin:

TSH: 1.13 (.4-4.50 miU/L)

T4 Free: 1.3 (.8-1.8 ng/DL)

T3 Free: 3.2 (2.3-4.2 pg/ML)

T3 Reverse: 10 (8-25 ng/DL)

FSH: 6.7 (1.6-8 miU/L)

LH: 3.9 (1.5-9.3 miU/L)

ESTROGEN, TOTAL, SERUM: 99.1 (60-190 (pg/mL))

DIHYDROTESTOSTERON,LCMSMS: 61 (16-79 (ng/dL))

TESTOSTERONE,TOT,LC/MS/MS: 856 (250-1100 ng/dL)

TESTOSTERONE,FREE: 71 (35-155 pg/mL)

TESTOSTERONE, Bioavailable: 142 (110-575 ng/dL)

ESTRADIOL Sensitive: 24 (<OR = 29 pg/mL)

FERRITIN: 112 (20-345 (ng/mL))

IRON,TOTAL: 148 (50-195 (mcg/dL))

IRON BINDING CAPACITY: 319 (250-425 (mcg/dL (calc))

VITAMIN D: 37 (30-100 (ng/mL))

THYROID PEROXIDASE AB: <1 (<9 (IU/mL))

THYROGLOBULIN ANTIBODIES: <1 (< OR = 1 (IU/mL))

SHBG: 67 (10-50 nmol/L) HIGH

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20

Add me to the list of people that have had issues related to finasteride. I took it for years, my sex drive actually steadily increased to the highest it’s been then went the other direction when I stopped taking it, started back and stopped again.

I can’t 100% say it was finasteride since my hormones had seemed to be all over the place a bit anyways but it feels very possible.

I have crazy high shbg as well (151) and obviously very low free T so I figured it was worth trying TRT to get my free T up before believing there was nothing else that could be done to fix me. I’ve had some days where I feel really good and some not so awesome ones. I think I’m going to need a higher dose to be honest but we’ll see I guess

Best of luck to you

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